Hormone replacement therapy gets new attention as FDA changes menopause warning guidance

Hormone replacement therapy has been used for decades, but it's getting renewed attention. Late last year, the FDA began removing long-standing warnings from some products and now, local medical professionals say more women are asking about them.  

For nearly 20 years, nurse practitioner Briston McClendon has treated women experiencing perimenopause and menopause. 

Then, in her late 40s, she started going through those changes herself.

"I went through symptoms like brain fog... sometimes I can't think clearly," she said. "I'm not sleeping well.. night sweats. Mood swings." 

She says she turned to hormone replacement therapy, or HRT, and started noticing a difference.

"HRT can be done in a variety of ways," she said. "You can do it in pellets, creams, patches, gels, shots. The hormones just helped to balance everything." 

For more than two decades, many HRT products came with the FDA's strongest warning, a black box warning. However, late last year, the FDA began removing some of those warnings, changing the conversation around hormone therapy. 

"Up until recently, the guidelines essentially said the recommendations are to give women the lowest dose of hormones possible for the shortest amount of time possible because there are all these scary risks in people, including breast cancer, strokes and heart attacks," Texas Health Presbyterian Hospital Dallas OB-GYN Dr. Emil Tajzoy said. 

He says many of those concerns date back to a study conducted more than 20 years ago.

"The kind of critical part of it all is the hormones they gave in the study were not even human bioidentical hormones," he said. 

Bioidentical hormones are made to be chemically identical to hormones naturally produced by the body.  

"The studies looking at those show a massive decreased risk in basically all the things that the original study said we had to worry about," he said.

He says that before making any decisions, it's important to consult with a medical professional. Treatment should be individualized based on a woman's symptoms, age, health history, and risk factors. 

For women who can't or don't want to take hormones, there are non-hormonal prescription medications and some over-the-counter products that can help with certain symptoms. 

However, Tajzoy stresses there's an important distinction. Those treatments primarily target individual symptoms and don't replace hormones.

"Aging itself is a disease and there's so much more we can do," he said. "Women who are 40-60 or beyond, a substantial proportion of their questions when they come in for their visits has something to do with hormones." 

"The conferences that I've been to over the years, learning about hormone therapy, started with a room of 30 people," McClendon said. "The last conference I went to, there were thousands and thousands of physicians there learning about hormone therapy." 

At Renew Beauty Med Spa, owner Louise Proulx says she's hearing more questions from women about whether HRT could be an option for them. 

"I think it's so important for women to have the conversation early," she said. "We should not be waiting until our 50s and 60s to understand hormone replacement therapy."

"For me, it's helped me dramatically in my romantic life because I feel better," McClendon said. "I'm less irritable. I'm sleeping better, so for me it just makes the biggest change." 

McClendon feels more like herself again and says she wants other women to know they don't have to navigate these changes alone.

Texas Health Dallas offers a free, physician-led support group and educational workshop series for women entering this stage of life.